Towards a health-informed approach to penal reform? Evidence from ten countries option is available.7 Thousands are detained every year in police cells under these powers, despite the obvious unsuitability of such environments for people who are mentally or emotionally vulnerable. Although guidance states that this should only happen in exceptional circumstances, the absence of hospital or similar facilities means that in many areas police cells are used more often than hospitals (Bather et al, 2008). This exemplifies a wider problem. When health services in the community are over-stretched or absent, the police may be the only agency available to respond. In lower income countries there may be more people with severe mental illness in prison than in psychiatric hospitals, because there are fewer resources for community psychiatric care (Fazel et al, 2016). In some developed countries (including the United States and England and Wales), recent decades have seen significant cuts in mental health service funding. The criminal justice system has to some extent filled the gap left by reduced community services and the closure of state mental hospitals (Grisso, 2008). Prisons have thus become a principal site of assessment and treatment. In some American states, prison administrations are now entitled forcibly to medicate mentally ill prisoners. This has been posited as a further explanation of significant increases in numbers of mentally ill prisoners in those states (Vars & Calambokidis, 2017). 7 Under Section 136 of the Mental Health Act 1983 (see footnote 27 below). 6